1932102084 NPI number — RAVI K ADUSUMILLI MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	ADUSUMILLI
Provider First Name	:	RAVI
Provider Middle Name	:	K
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1932102084
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	12/23/2009
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	2940 N MCCORD RD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	TOLEDO
Provider Business Mailing Address State Name	:	OH
Provider Business Mailing Address Postal Code	:	436151753
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	4198423000
Provider Business Mailing Address Fax Number	:	4198423048

Provider First Line Business Practice Location Address	:	2940 N MCCORD RD
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	TOLEDO
Provider Business Practice Location Address State Name	:	OH
Provider Business Practice Location Address Postal Code	:	436151753
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	4198423000
Provider Business Practice Location Address Fax Number	:	4198423048
Provider Enumeration Date	:	05/23/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 207RC0000X , with the licence number:  4301081344 , registered in the state of MI .
• Taxonomy code: 207RC0000X , with the licence number: 35069014 , registered in the state of OH .

• Identifier: 4042629 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: P00751116 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "".
• Identifier: 0792002 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: AD4257781 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: E21287 . This identifiers is of the category "".
• Identifier: MI1635021 , issued by the state of ( MI ) . This identifiers is of the category "".
• Identifier: 0792003 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 060060579 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 4042627 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 4042628 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 0178623 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 4042622 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 4042624 , issued by the state of ( OH ) . This identifiers is of the category "".